This blog is about freedom and personal responsibility. I have opined that cigarette smokers should not be permitted to transfer total responsibility for the consequences of their choices to the tobacco companies, even if this industry has committed legal and ethical improprieties. I do not support the politically correct beverage ban in New York City, sure to spread elsewhere, where the government decides the content and dimensions of beverages that the public desires to purchase. With regard to Obamacare, don’t get me started or I’ll never get to the intended subject of this post.

First, let me refute a point in advance that is sure to be leveled against me by the pro-breast crowd. I am zealously pro-breast and want all breasts foreign and domestic to remain free of disease. I am against breast cancer and support the goal of striving for early detection of this disease and medical research to prevent it. Indeed, I am against all cancer and boldly express this controversial view in print for all to see.

Breasts and politics have been intertwined for years. Many medical advocacy groups admire and envy the huge amount of research money that is garnered for breast cancer research. Some argue that breast cancer, while worthy, receives a disproportionate share of research dollars at the expense of other crippling and deadly diseases.

There is no clearer example of the contamination of breast cancer with political interference than Mammogate, when the federal government cowardly rejected the sound and impartial recommendations of its own expert panel for political reasons.

Now, a new scene in the government's Breast Fest has appeared where our elected legislators play doctor. States are passing laws that require medical facilities to inform patients who have undergone mammograms if they have dense breast tissue and that they should discuss with their physicians if additional testing is necessary. More details are found in the New York Times report on this issue.

I will defer expressing a medical view if women with dense breasts are adequately protected by conventional mammography. If medical professionals, unelected but presumably trained in actual medicine, believe that ultrasound exams or M.R.I. scans are necessary to illuminate dense breast tissue, then brace yourself for an avalanche of unnecessary scans which will generate anxiety, cost a few zillion dollars and identify false positive lesions which are entirely innocent and lead to a breast biopsy bonanza. This cascade will be fueled also by the medical malpractice system, the raptor present in every mammography suite that is ready to sink talons into its prey. Am I exaggerating here? Ask any radiologist why he has stopped reading mammograms. They guys that still do are scared stiff. These breast images are not sharp iPad images with futuristic resolution. Instead, they look like grainy collages where it can be agonizing for a doctor to decide if a small smudge is nothing or everything. Understandably, in today's litigious climate, radiologists join OperationOVERCALL, rather than risk the opportunity to serve as a defendant years later.

The government are not physicians and should not legislate medical advice. It’s hard enough for actual doctors to sort through conflicting and controversial medical data and evidence to determine what is best for our patients. We struggle with this every day. Will the clumsy axe of government be a helpful player in this effort? Do we want folks who are beholden to lobbyists and are political animals by definition to force physicians to practice in certain way?

Why stop at breasts?

Pass laws that will require physicians to

Obtain a CXR if a patient has a cough and a fever

Tell every patient who has a negative cardiac stress test that the patient can drop dead of a heart attack within a week and that a cardiac catheterization should be considered

advise patients who are scheduled for surgery to obtain a second opinion in case surgery is silly

advise patients to pursue the probiotic promise of a panacea.

Sure, there's dense breast tissue out there. But, not nearly as dense as the government. I suppose we should trust them with our lives and our health judging by the sterling performance they demonstrate as legislators. Congress' approval rating is now soaring at 21%.

I am a full time practicing physician and writer. I write about the joys and challenges of medical practice including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When I'm not writing, I'm performing colonoscopies.

One of the medical malpractice suits that I have encountered was very recently. It was filed by a young woman was found to have lesions through her mammogram and ultrasound results. Although the lesions were minute, these were believed to be irregular in shape. She was then advised to have it removed through a non-invasive procedure called mammotome. Although the procedure was believed to be safe, the surgeon accidentally pricked a part of the breast that proved to be a little painful for the young woman. The procedure when as normal but after two weeks, the young woman was still experiencing some pain. It was later found out that the doctor has skipped a step and caused some infection inside the woman’s breast, which led her to do breast mastectomy.

Yes, an excellent and enlightening post. It is absolutely true that breast cancer has been a highly politicized disease, really since the 1970's. Mammography, which has been considered the gold standard of breast cancer diagnosis since that time, has been pushed as the panacea for complete breast health. Although I have been an avid supporter of screening, I now see that the aggressive push for across the board screening has not been everything it was cracked up to be. When renowned breast surgeon and advocate, Susan Love defended the recommendations of the US Preventive Services Task Force (2009), there was a firestorm of controversy. But she was saying things that actually reflected new knowledge of breast cancer pathology-some bad and aggressive cancers will be deadly regardless of when they are found and some slow growing cancers will be curable even if discovered later. Mammography, now an old technology, has not been applied in a way that reflects this new knowledge. This new legislation regarding dense breasts will, no doubt, lead to even more false positive results. More tests, biopsies, etc. MRI's are very sensitive, but not very specific, meaning that they will pick up many little artifacts that may be benign or prove to be nonexistent findings. It is a real shame, alright, when this kind of policy gets passed off, and ultimately accepted as being in the pateint's interest.

Finally - a blogger with sense that hasn't been brainwashed by the idiots trying to legislate every part of our lives, even though they know little about what they are legislating. Leave the practice of medicine to the individuals' doctors. Now that I am covered by an HMO (the school district that employs my husband took away our PPO) I have so many limitations placed on the care I want to receive. I have conditions that aren't run-of-the-mill, and the "suggestions" for medical care for certain conditions being issued by these govt-created policy-making groups literally leave irate people like me out in the rain - unable to get care for our conditions simply b/c we don't fit into the tidy pigeonholes created by these quasi-governmental agencies. In fact, this is exactly how I think ins companies are going to get away with denying care for those people that pay thousands for coverage, yet still operate under the ACA w/o recourse or penalty.